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Comprehensive Psychiatry 57 (2015) 21 – 28
www.elsevier.com/locate/comppsych

The relationship between parental mediation and Internet addiction among

adolescents, and the association with cyberbullying and depression
Fong-Ching Chang a,⁎, Chiung-Hui Chiu b , Nae-Fang Miao c , Ping-Hung Chen d ,
Ching-Mei Lee a , Jeng-Tung Chiang e , Ying-Chun Pan a
a
Department of Health Promotion and Health Education, National Taiwan Normal University, Taiwan
b
Graduate Institute of Information and Computer Education, National Taiwan Normal University, Taiwan
c
Department of Nursing, Taipei Medical University, Taiwan
d
The Graduate Institute of Mass Communication, National Taiwan Normal University, Taiwan
e
Department of Statistics, National Chengchi University, Taiwan

Abstract

Objective: This study examined the relationships between parental mediation and Internet addiction, and the connections to cyberbullying,
substance use, and depression among adolescents.
Method: The study involved 1808 junior high school students who completed a questionnaire in Taiwan in 2013.
Results: Multiple logistic regression analysis results showed that adolescents who perceived lower levels of parental attachment were more
likely to experience Internet addiction, cyberbullying, smoking, and depression, while adolescents who reported higher levels of parental
restrictive mediation were less likely to experience Internet addiction or to engage in cyberbullying. Adolescent Internet addiction was
associated with cyberbullying victimization/perpetration, smoking, consumption of alcohol, and depression.
Conclusion: Internet addiction by adolescents was associated with cyberbullying, substance use and depression, while parental restrictive
mediation was associated with reductions in adolescent Internet addiction and cyberbullying.
© 2014 Elsevier Inc. All rights reserved.

1. Introduction negative consequences, and impaired decision-making

Internet addiction is an emerging public health issue. The
rise of new technologies, such as the Internet and associated
social media sites, has exposed adolescents to online risks
(pornography exposure, cyberbullying and Internet addic-
tion) and health risks (depression and suicide), which have
increased the rates of youth morbidity and mortality [1,2].
Studies have associated Internet addiction with increases in
youth cyberbullying problems [3,4] that can cause mental,
physical and social harm [5].
Despite wide variations in the instruments that have been
used for the diagnosis of Internet addiction, it is character-
ized by preoccupation, uncontrolled impulses, use that is
more than intended, tolerance, withdrawal, impairment of
control, devotion of excessive time and effort despite
⁎ Corresponding author at: 162, Ho-Ping E. Rd., Sec.1, Taipei 10610,
Taiwan. Tel.: +886 2 77341711; fax: +886 2 23630326.
E-mail address: fongchingchang@ntnu.edu.tw (F.-C. Chang).
http://dx.doi.org/10.1016/j.comppsych.2014.11.013
0010-440X/© 2014 Elsevier Inc. All rights reserved.
[6,7]. Studies have associated Internet addiction with online
activities such as watching online pornography, online
gambling [8], using social networking sites and online
gaming [9], and online chatting [10]. Internet addiction is
currently not included in the Diagnostic and Statistical
Manual of Mental Disorders (DSM) V, but Internet gaming
disorder is listed in Section 3 as requiring further research.
In addition, studies have associated Internet addiction
with psychiatric forms of co-morbidity such as consumption
of alcohol [11,12], smoking [13,14], attention deficit and
hyperactivity, hostility [15], loneliness [16], low self-esteem
[17,18], and depression [14,19].Moreover, studies have
associated factors such as low family functioning [17,20],
family dissatisfaction [11], poor parent–adolescent relation-
ships [21,22], and low parental monitoring [23,24] with
Internet addiction among adolescents. In contrast, forms of
parental restrictive mediation such as rules regarding the
time spent online have been negatively associated with
Internet addiction [25] and cyberbullying [26–28].
22 F.-C. Chang et al. / Comprehensive Psychiatry 57 (2015) 21–28
The prevalence of Internet addiction among adolescents is
known to be higher in Asian societies than in Western
countries [29]. Despite studies that have documented the
psychosocial factors associated with Internet addiction, there
has been little research examining parental mediation of
youth Internet addiction and cyberbullying in Asian
societies. Few studies have examined the relationships
between Internet addiction, online risks, and health risks.
The present study canvassed junior high school students in
Taiwan to compare parental attachment, parental mediation,
online risks (cyberbullying and online sexual solicitation),
and health risks (dietary behavior, substance use, low self-
esteem, and depression) between a group that was addicted
to the Internet and one that was not. The relationships
between parental mediation, Internet addiction, cyberbully-
ing, substance use, and depression were also examined.
2. Methods
2.1. Participants and procedures
In 2013, a total of 86,887 students attended 62 junior high
schools in Taipei City, while 18,353 students attended 25
junior high schools in Yilan county, Taiwan. Based on the
sampling frame, which was a list of schools and their student
enrollments, a probability-proportionate-to-size sampling
method was used to systematically draw a random sample
of schools. Eighteen schools in Taipei city and 11 schools in
Yilan county agreed to participate in this survey. Three to
four classes were randomly selected from each sample
school. Approval from the Institutional Review Board at
National Taiwan University was obtained.
Following class selection, teachers helped give students
consent forms to take home to parents requesting consent to
have their child participate in the survey. Students also filled
out a consent form to indicate their willingness to participate
in this study. After the consent forms were collected,
researchers visited the schools to conduct the self-administered
survey and address students’ questions. Students were assured
the information would remain confidential and anonymous. A
total of 1079 and 838 students in Taipei city and Yilan county,
respectively, completed the questionnaire. About one-fifth of
students declined to participate in this study. The response rate
was 82%.
2.2. Instrument
The self-administered questionnaire was developed based
on previous studies such as the EU Kids online survey [30]
and the U.S. Youth Internet Safety Survey [31,32]. A group
of 8 experts was invited to assess the content validity of the
questionnaire. Experts reviewed the draft questionnaire and
provided comments and suggestions for improvements. In
addition, a pilot survey was conducted at two schools that
were not included as sample schools in order to examine the
students’ responses to the survey and to evaluate the
reliability of the data that the questionnaire would yield.
2.2.1. Online activities
Adolescent Internet use and online gaming weekly use
hours were calculated from two questions. a) During the past
week, how much time did you spend on the Internet/playing
online games per weekday (Monday to Friday)? The
response options included the following: “0 min,” “1–29
min,” “30–59 min,” “1 hour–less than 2 hours,” “2 hours–
less than 3 hours,” or “3 hours and more—please fill in the
number of hours.” b) During the past week, how much time
did you spend on the Internet, and playing online games per
weekend day (Saturday and Sunday)? The response options
included the following: “0 hour,” “1 hour,” “2 hours,” “3
hours,” “4 hours,” or “5 hours and more—please fill in the
number of hours.” In addition, participants were asked how
many days during the past week they used social network
websites/chat rooms.
2.2.2. Internet addiction
Internet addiction was assessed using the Chen Internet
Addiction Scale [33]. The Chen Internet addiction scale
contains 26 items to assess the core symptoms of Internet
addiction and the related problems connected to Internet
addiction. For example, participants were asked whether
they agreed or disagreed with a statement such as the
following: “I find that I stay online longer than I intended,” “I
neglect family interaction to spend more time online,” and, “I
feel that life would be boring without the Internet.” Each
item was evaluated on a 4-point Likert-type scale that ranged
from “strongly agree” (scoring 4) to “strongly disagree”
(scoring 1). The total score of the scale ranged from 26 to
104. The Cronbach’s α of the Chen Internet addiction for the
sample was 0.94. A threshold score of 63/64 was suggested
to provide good diagnostic accuracy with respect to Internet
addiction among adolescents [34]. Students with a score of
64 or higher were classified as having an Internet addiction.
2.2.3. Parental mediation
Parental mediation measures were adapted from the study
of 2010 EU Kids Online survey parental mediation scale
[30]. Adolescents provided reports of parental mediation
including 5 types of rules and practices: active use mediation
(4 items), active safety mediation (4 items), monitoring
mediation (4 items), technical mediation (4 items), and
restrictive mediation (5 items). A sample question of active
use mediation was “Do your parents talk to you about what
you do on the Internet?” A sample question about active
safety mediation was “Do your parents suggest to you ways
to use the Internet safely?” A sample question concerning
monitoring mediation for adolescents was “Do your parents
watch which websites you visit?” A sample question about
technical mediation was “Do your parents use filter programs
or other means of blocking some types of websites?” The
response options for active use, active safety, monitoring,
and technical mediation were “no” (scoring 0) and “yes”
 F.-C. Chang et al. / Comprehensive Psychiatry 57 (2015) 21–28
(scoring 1). A sample question about restrictive mediation
was “Do your parents allow you to use forms of instant
messaging such as Skype?” The responses included “can do
this” (scoring 0), “can only do this with permission or
supervision” (scoring 1), and “can never do this” (scoring 2).
A higher score indicated higher parental mediation. The
Cronbach’s α of active use, active safety, monitoring,
technical, and restrictive mediation subscales were 0.51,
0.76, 0.73, 0.65, and 0.77, respectively.
2.2.4. Parental attachment
Parental attachment was measured using 2 items.
Participants were asked the following: “Do you get along
with your mother,” and, “Do you get along with your
father?” Response options used a four-point Likert-type scale
that ranged from “not very good” (scoring 1) to “very good”
(scoring 4). Higher scores were equated with a higher level
of parental attachment.
2.2.5. Online violence and pornography exposure
Online violence and pornography content exposure was
measured based on the respondent’s answer to the following:
During the past year, how often did you 1) see messages
containing violence on the Internet or online games; and, 2) see
messages containing pornography on the Internet or in online
games. Response options for each item included the following:
“never” (scoring 1), “a few times yearly” (scoring 2), “a few
times monthly” (scoring 3), “a few times weekly” (scoring 4),
and “almost daily” (scoring 5). A higher score indicated higher
online violence/pornography content exposure.
2.2.6. Cyberbullying victimization/perpetration
Cyberbullying victimization was measured using 4 items.
Participants were asked the following questions. 1) How
often has someone made or posted rude comments to, or
about, you online? 2) How often has someone posted
embarrassing or nude photos of you online? 3) How often
has someone spread rumors about you online? 4) How often
has someone bullied or hurt you online? Cyberbullying
perpetration was measured using 4 items. Participants were
asked the following questions: How often have you ever
done the following: 1) made rude comments to anyone
online; 2) sent or posted others’ embarrassing photos online;
3) spread rumors about someone online; or, 4) made
threatening comments to hurt someone online? Response
options for each item included the following: “never,”
“happened a year ago,” “a few times within a year,” “a few
times a month,” and, “a few times a week.” If participants
answered “a few times within a year,” or more frequently, for
any of the cyberbullying victimization/perpetration items,
they were coded as having engaged in cyberbullying
victimization/perpetration.
2.2.7. Online sexual solicitation victimization/perpetration
Online sexual solicitation victimization was measured
using 2 items. Participants were asked the following
questions: 1) How often has someone asked you to talk
23
about sex online when you did not want to; and, 2) How
often has someone asked you to do something sexual online
that you did not want to? Online sexual solicitation
perpetration was measured using 2 items. Participants were
asked the following questions: 1) How often have you asked
someone to talk about sex online when they did not want to;
2) How often have you asked someone to do something
sexual online when they did not want to? Response options
for each item included the following: “never,” “happened a
year ago,” “a few times within a year,” “a few times a
month,” and, “a few times a week.” If participants answered
“a few times within a year,” or more frequently, for any of
the online sexual solicitation victimization/perpetration
items, they were coded as having engaged in online sexual
solicitation victimization/perpetration.
2.2.8. Internet literacy
Internet literacy was measured using 6 items. Sample
questions included the following. “When I receive uncom-
fortable messages (i.e., pornography, violence) online, I will
leave the webpage.” “When someone holds a different
opinion online, I will express my thoughts clearly and won’t
scold them back.” “When someone asks me to talk about sex
online or to do something sexual that I do not want to do, I
will leave the webpage.” And “It is illegal to steal treasures
from other people in online games.” Each item was evaluated
using a 4-point Likert-type scale that ranged from “strongly
agree” (scoring 4) to “strongly disagree” (scoring 1). A
higher score indicated a higher degree of an adolescent’s
Internet literacy. The Cronbach’s α of the adolescents’
Internet literacy was 0.83.
2.2.9. Tobacco and alcohol use
Tobacco use was measured based on the respondent’s
answer to how often they had ever smoked. Alcohol use was
measured based on the respondent’s answer to how often
they had ever consumed alcohol. Response options for each
item included the following: “never,” “ever before a year,” “a
few times within a year,” “a few times a month,” and “a few
times a week.” If participants answered “a few times within a
year,” or more frequently, they were coded as smokers/
alcohol drinkers.
2.2.10. Self-esteem.
Self-esteem was assessed using the Rosenberg self-
esteem scale [35]. The Rosenberg self-esteem scale contains
10 items that provide a general measure of global self-
esteem. For example, participants were asked whether they
agreed or disagreed with a statement such as the following:
“On the whole, I am satisfied with myself,” “I am able to do
things as well as others,” and, “I take a positive attitude
toward myself.” Each item was evaluated on a 4-point
Likert-type scale that ranged from “strongly agree” to
“strongly disagree.” The total score of the scale ranged
from 0 to 30. Students with a score of 14 or less were
classified as having low self-esteem. The Cronbach’s α for
self-esteem scale in the present sample was 0.85.
24 F.-C. Chang et al. / Comprehensive Psychiatry 57 (2015) 21–28

2.2.11. Depression. Table 1

Depression was measured using the Center for Epidemi- Demographic characteristics by Internet addiction status.
ologic Studies Depression Scale (CES-D) [36]. The CES-D Non-Internet Internet Chi-square test
is a 20-item scale that evaluates the presence of depressive addiction addiction
symptoms. Participants were asked during the past week n % n % p-value
how often they experienced feelings such as the following: “I Gender b0.0001
was bothered by things that don’t usually bother me,” and “I Female 851 54.1 113 38.6
did not feel like eating; my appetite was poor.” Response Male 721 45.9 180 61.4
options for each item included the following: “rarely or none School grade 0.0995
7th grade 640 40.7 100 34.0
of the time (b1 day),” “some or a little of the time (1–2 8th grade 560 35.6 117 39.8
days),” “occasionally or a moderate amount of the time (3 9th grade 373 23.7 77 26.2
days),” or “most or all of the time (5–7 days).” The total Area 0.2853
score of the scale ranged from 0 to 60. Students with 29 or Urban 878 55.8 174 59.2
higher were classified as having depression [37]. The Rural 695 44.2 120 40.8
Household poverty 0.5556
Cronbach’s α of the CES-D scale for the present sample No 1176 74.8 215 73.1
was 0.90. Yes 397 25.2 79 26.9
Academic performance b0.0001
Average or above 1274 79.3 180 61.2
2.2.12. Adolescent characteristics Below average 326 20.7 114 38.8
Adolescent characteristics obtained in the present study
included gender (male vs. female), school grade (7th, 8th or
9th grade), area (urban vs. rural), household poverty (yes
3.2. Adolescent online risks and parental mediation by
vs. no), and academic performance (average or above vs.
Internet addiction status
below average).
Adolescent online activities, risks, and parental mediation
by Internet addiction status are shown in Table 2. The Internet-
2.3. Statistical analysis addicted group spent more time online (14.3 h/week) and
SAS software was used to perform the statistical analysis. online gaming (9.9 h/week) than the non-addicted group
Percentages and means were calculated for all variables. Chi- (online: 8.5 h/week, online gaming: 4.5 h/week). In addition,
square and t tests were conducted to compare the Internet- the Internet-addicted group spent more days per week on
addicted group with the non-addicted group with respect to social network websites (5.1 days/week) and chat rooms
adolescents’ characteristics, online activities, online risks, (2.8 days/week) than the non-addicted group (social network
and health risks. Multiple logistic regression analyses also websites: 3.7 days/week, chat room: 1.7 days/week). More-
were performed to identify factors related to Internet over, the Internet-addicted group reported greater levels of
addiction, cyberbullying victimization/perpetration, smok- online pornography and violence content exposure than the
ing, alcohol use, and depression. non-addicted group.
In addition, the Internet-addicted group reported lower
levels of parental restrictive mediation and active safety
parental mediation of child’s Internet use than the non-
addicted group. The Internet-addicted group also reported
3. Results lower levels of parental attachment than the non-addicted
group. Moreover, the Internet-addicted group reported fewer
3.1. Adolescent characteristics by Internet addiction status days per week eating vegetables and fruit and more days per
Adolescent demographic characteristics by Internet week consuming sugary drinks compared with the non-
addiction status are shown in Table 1. Of the 1867 students, addicted group (Table 2).
294 (15.8%) were classified as having an Internet addiction. 3.3. Cyberbullying, substance use and mental health by
The percentage of males was significantly higher (61.4%) in Internet addiction status
the Internet-addicted group than in the non-addicted group
(45.9%). In addition, the percentage recording poor Occurrences of adolescent cyberbullying, substance use,
academic performance was significantly higher (38.8%) and mental health issues by Internet addiction status are shown
in the Internet-addicted group compared with the non- in Table 3. The Internet-addicted group had significantly
Internet addicted group (20.7%). The percentages for grade higher rates of cyberbullying victimization (30.0%), cyber-
level in school, region of residency (rural vs. urban), and bullying perpetration (24.2%), online sexual solicitation
incidence of household poverty were not significantly victimization (18.8%), and online sexual solicitation perpe-
different between the Internet-addicted group and the non- tration (5.5%) than the non-addicted group (cyberbullying
addicted group. victimization: 12.9%, cyberbullying perpetration: 7.8%,
 F.-C. Chang et al. / Comprehensive Psychiatry 57 (2015) 21–28 25

Table 2
Online activities, risks, and parental mediation by Internet addiction status.
Non-Internet addiction Internet addiction t test
Mean SD Mean SD p-value
Online activities
Internet use (h/wk) 8.5 8.9 14.3 12.7 b0.0001
Online gaming (h/wk) 4.5 7.0 9.9 10.4 b0.0001
Social network website (day/wk) 3.7 2.7 5.1 2.5 b0.0001
Chat room (day/wk) 1.7 2.5 2.8 3.0 b0.0001
Online content risks
Pornography content exposure 1.9 1.1 2.6 1.3 b0.0001
Violence content exposure 2.3 1.3 2.8 1.3 b0.0001
Parental mediation
Active use 2.0 1.2 2.2 1.3 0.1267
Active safety 2.1 1.5 1.9 1.6 0.0155
Monitoring 1.5 1.4 1.6 1.5 0.0927
Technical 1.1 1.2 1.2 1.3 0.3527
Restrictive 1.9 2.3 1.3 1.8 b0.0001
Parental attachment 4.2 0.8 3.8 0.8 b0.0001
Dietary behavior
Vegetable/fruit intake (day/wk) 4.5 2.2 3.9 2.4 0.0008
Sugary drink intake (day/wk) 2.9 2.8 3.9 3.6 b0.0001
Non-Internet addiction n=1571; Internet addiction n= 293.

online sexual solicitation victimization: 8.7%, and online
sexual solicitation perpetration: 1.2%). In addition, the
Internet-addicted group reported significantly higher rates of
smoking (12.0%) and consumption of alcohol (36.0%) than
the non-addicted group (smoking: 4.7%, consumption of
alcohol: 19.5%). Moreover, the Internet-addicted group also
had higher rates of low self-esteem (25.9%) and depression
(22.4%) than the non-addicted group (low self-esteem: 15.5%,
depression: 9.1%).
3.4. Factors related to Internet addiction and cyberbullying
Multiple logistic regression analysis results showed that
factors associated with Internet addiction included the
following: male gender, poor academic performance, lower
Internet literacy, lower parental attachment,higher active use
parental mediation, lower active safety parental mediation, and
lower restrictive parental mediation. In addition, factors
associated with cyberbullying victimization/perpetration in-
cluded male gender, higher school grade, lower Internet
literacy, lower parental attachment, lower parental restrictive
mediation, and Internet addiction (Table 4).
3.5. Relationships between Internet addiction, substance
use, and depression
Multiple logistic regression analysis results showed that
after controlling for other factors, Internet addiction,
cyberbullying perpetration and depression were associated
with smoking and consumption of alcohol. In addition, after
controlling for other factors, Internet addiction, cyberbully-
ing victimization, and poor academic performance was
associated with depression (Table 5).

Table 3
Online risks and health risks by Internet addiction status. 4. Discussion
Non- Internet Chi-square
Internet addiction test One-seventh of the junior high school students canvassed
addiction in this study could be characterized as having an Internet
n % n % p-value addiction. Consistent with prior studies [9,10,38], our results
showed that male students were more likely to be addicted to
Online contact risks
Cyberbullying victimization 203 12.9 88 30.0 b0.0001 the Internet. This may have been due to the time spent by
Cyberbullying perpetration 123 7.8 71 24.2 b0.0001 males playing online games, while females spent more time
Online sexual solicitation victimization 136 8.7 55 18.8 b0.0001 on social network sites [38,39]. In addition, this and other
Online sexual solicitation perpetration 19 1.2 16 5.5 b0.0001 studies [20,40] found that students who had poor academic
Substance use
performance were more likely to develop an Internet addiction.
Smoking 74 4.7 35 12.0 b0.0001
Alcohol consumption 305 19.5 105 36.0 b0.0001 The development and implementation of Internet addiction
Mental health prevention programs should include gender-specific compo-
Low self-esteem 242 15.5 75 25.9 b0.0001 nents and vulnerable group considerations.
Depression 139 9.1 64 22.4 b0.0001 Our results were similar to prior studies [21,25,41,42] that
Non-Internet addiction n=1571; Internet addiction n= 293. found lower parental attachment was related to Internet
26 F.-C. Chang et al. / Comprehensive Psychiatry 57 (2015) 21–28

Table 4 Table 5
Factors of Internet addiction and cyberbullying victimization/perpetration. Factors of smoking, alcohol consumption, and depression.
Internet Cyberbullying Cyberbullying Smoking Alcohol Depression
addiction victimization perpetration drinking
O.R. 95%CI O.R. 95%CI O.R. 95%CI O.R. 95%CI O.R. 95%CI O.R. 95%CI
Gender (male=1, 1.66 1.26–2.19 1.62 1.23–2.13 1.59 1.14–2.22 Gender (male=1, 1.49 0.97–2.28 0.85 0.67–1.08 0.59 0.43–0.81
female=0) female=0)
School grade 1.08 0.91–1.29 1.20 1.01–1.43 1.35 1.09–1.67 School grade 1.29 0.99–1.67 1.44 1.25–1.67 1.00 0.82–1.22
Area (rural=1, 0.83 0.63–1.10 0.69 0.53–0.92 0.85 0.61–1.18 Area (rural=1, 2.80 1.82–4.33 0.98 0.77–1.24 0.80 0.58–1.10
urban=0) urban=0)
Poor academic 2.37 1.77–3.16 1.05 0.77–1.44 1.09 0.75–1.58 Poor academic 2.47 1.61–3.70 1.27 0.97–1.66 1.59 1.13–2.22
performance performance
(yes=1, no=0) (yes=1, no=0)
Internet literacy 0.45 0.35–0.58 0.53 0.41–0.68 0.40 0.30–0.54 Parental attachment 0.73 0.58–0.92 0.91 0.80–1.05 0.65 0.55–0.77
Parental attachment 0.74 0.63–0.86 0.79 0.68–0.93 0.78 0.65–0.95 Internet addiction 1.59 0.99–2.55 1.73 1.28–2.33 1.92 1.33–2.76
Parental mediation (yes=1, no=0)
Active use 1.24 1.08–1.42 1.07 0.93–1.22 1.02 0.87–1.20 Cyberbullying 1.44 0.85–2.45 1.22 0.88–1.69 2.54 1.73–3.72
Active safety 0.84 0.74–0.94 0.96 0.85–1.08 0.92 0.79–1.06 victimization
Monitoring 1.09 0.98–1.22 1.03 0.92–1.15 1.07 0.93–1.23 (yes=1, no=0)
Technical 1.06 0.93–1.21 1.14 1.00–1.29 1.05 0.90–1.23 Cyberbullying 2.27 1.27–3.87 2.07 1.44–2.99 1.23 0.78–1.94
Restrictive 0.87 0.81–0.94 0.89 0.82–0.95 0.83 0.75–0.91 perpetration
Internet addiction 1.82 1.32–2.52 2.13 1.47–3.07 (yes=1, no=0)
(yes=1, no=0) Depression (yes=1, 1.76 1.04–2.97 1.47 1.04–2.07
no=0)
Multiple logistic regression was conducted.
Smoking (yes=1, 1.43 0.81–2.52
Internet addiction model N=1790 (yes n=284, no n=1506).
no=0)
Cyberbullying victimization model N=1787 (yes n=278, no n=1509).
Alcohol 1.37 0.95–1.98
Cyberbullying perpetration model N=1787 (yes n=182, no n=1605).
consumption
(yes=1, no=0)
Multiple logistic regression was conducted.
addiction and cyberbullying, while parental restrictive
Smoking model N=1792 (yes n=106, no n=1686).
mediation was negatively associated with adolescent Internet Alcohol consumption model N=1792 (yes n=398, no n=1394).
addiction and cyberbullying. Other studies [43,44] also Depression model N=1791 (yes n=202, no n=1589).
found that parenting style was associated with adolescent
Internet addiction and cyberbullying. Studies suggested that
measures such as promoting family functions and parental Internet addiction screening should include other psychiatric
mediation of Internet use by children were needed to prevent disorders in order to improve the management and prognosis
Internet addiction and online risks [45,46]. of Internet addiction [51–53].
This study was consistent with prior studies [13,14,47,48] This study found that adolescents with an Internet
that found that Internet addiction was associated with youth addiction had greater levels of online content risks (online
tobacco and alcohol use. In addition, this study and prior pornography/violence exposure), online contact risks (cyber-
studies [3,4] found that adolescent Internet addiction was bullying victimization/perpetration and online sexual solic-
associated with cyberbullying perpetration and cyberbullying itation victimization/perpetration), and health risks (more
victimization. A study [49] found that Internet addiction and sugary drinks, less vegetable/fruit intake, smoking, alcohol
alcohol dependence share common characteristics that may use, low self-esteem, and depression) compared with
lead to aggression. Future research should examine possible adolescents who were not addicted to the Internet. Other
neurobiological similarities between substance use disorders studies [54,55] have also found that adolescents with an
and behavioral addictions [50]. Moreover, this study found Internet addiction were more likely to have inappropriate
that adolescents’ Internet literacy was associated with dietary behaviors, poor diet quality [54], a negative lifestyle
reductions in Internet addiction and cyberbullying. The [55], a habit of watching online pornography, and a habit of
strengthening of youth digital literacy is suggested for schools online gaming [8]. These results confirm the importance of
and families in order to prevent youth online risks. implementing Internet addiction prevention programs in
Moreover, this study found that Internet addiction and order to prevent mental and physical harm to youth.
cyberbullying victimization were associated with depression.
Adolescents with an Internet addiction may have more 4.1. Limitations
chances to engage in cyberbullying perpetration and/or
victimization, while cyberbullying experiences may exacer- This research had some limitations. First, social desir-
bate depression. Other studies have also indicated that ability bias may have influenced the truthfulness of reports of
Internet addiction is comorbid with depression and hostility online risks by adolescents. However, confidentiality was
[19]. Due to high comorbidity, studies have suggested that emphasized, and trained investigators immediately collected
 F.-C. Chang et al. / Comprehensive Psychiatry 57 (2015) 21–28
the questionnaires. Second, about one-fifth of students
declined to participate in this study. Potential biases from
selection and refusal to participate must be considered.
Finally, this study was cross-sectional. The study precluded
causal inferences. Future research is needed to examine the
longitudinal influences of parental mediation on adolescents’
Internet risks and longitudinal relationships between Internet
addiction, online risks, and health risks.
4.2. Conclusion
One-seventh of the junior high school students canvassed
in this study were addicted to the Internet. Adolescents with
an Internet addiction had greater levels of online risks
(pornography/violence exposure, cyberbullying, and online
sexual solicitation) and health risks (less vegetable/fruit
intake, more consumption of sugary drinks, smoking,
consumption of alcohol, low self-esteem, and depression).
Multiple logistic regression analysis results indicated that
adolescents with an Internet addiction were more likely to
engage in cyberbullying victimization/perpetration, smok-
ing, consumption of alcohol, and depression. In addition,
adolescents who perceived lower parental attachment were
more likely to have an Internet addiction, engage in
cyberbullying, be a smoker, and experience depression,
while adolescents who perceived parental restrictive medi-
ation were less likely to have an Internet addiction and to
engage in cyberbullying victimization/perpetration.
Acknowledgment
This work was supported by a research grant from the Taiwan
National Science Council (NSC 101-2511-S-003-029-MY2).
Many thanks go to the participant schools, students and parents.
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